Acute aortic dissection should be suspected with pulse or neurologic deficit and hypotension

April 23, 2018, Society for Academic Emergency Medicine

In the appropriate clinical setting, suspicion for acute aortic dissection should be raised when patients present with findings that have a high specificity and high positive likelihood ratio (hypotension, pulse deficit, or neurologic deficit). That is the finding of a study to be published in the April issue of Academic Emergency Medicine, a journal of the Society for Academic Emergency Medicine (SAEM).

The lead author is Dr. Robert Ohle, MB, BCh, BAO, MSc, MA, Department of Emergency Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario.

The study by Ohle, et al, suggests that, conversely, findings with a high sensitivity and low negative likelihood ratio (a low American Heart Association aortic dissection detection score) decrease likelihood of aortic dissection in patients with chest pain. The authors propose that clinical gestalt informed by high- and low-risk features together with an absence of an alternative diagnosis should drive investigation for .

Ohle, et al, recommend that further investigation for acute should be guided by evidence-informed clinical suspicion and through a shared decision-making process with patients.

Dr. Ohle: "Aortic dissection: Your gestalt is the only tool you have... make sure it's informed by the appropriate high and low risk clinical characteristics."

The findings of the study are discussed with Dr. Ohle in the featured episode of SGEM Hop (Skeptics Guide to EM Hot Off the Press).

Explore further: Patients with high-risk clinical features are at high risk for acute aortic dissection

More information: Robert Ohle et al, Clinical Examination for Acute Aortic Dissection: A Systematic Review and Meta-analysis, Academic Emergency Medicine (2017). DOI: 10.1111/acem.13360

Related Stories

Patients with high-risk clinical features are at high risk for acute aortic dissection

April 10, 2018
Patients with one or more high-risk clinical features (tearing pain, hypotension, pulse deficit, neurologic deficit, new murmur) should be considered high risk for acute aortic dissection (AAD). That is the finding of a study ...

Role of intravascular ultrasound imaging in detection of acute aortic syndrome

April 18, 2018
In the current issue of Cardiovascular Innovations and Applications, Niya Mileva, Medical University of Sofia, Sofia, Bulgaria and other researchers from Poland and Italy present a case study of misdiagnosed aortic intramural ...

Genetic mutation linked to aortic dissection in the chest

May 11, 2017
Researchers at Umeå University in Sweden have discovered a genetic mutation that can cause dissection of the thoracic aorta, which is the body's main artery. The mutation leads to an impaired function of the smooth muscle ...

Fluoroquinolones linked to increased risk of aortic disease

March 9, 2018
New research from a Swedish and Danish team of researchers led from Karolinska Institutet lend additional support to a link between treatment with fluoroquinolone antibiotics and an increased risk of acute aortic disease. ...

Serious heart problem a family matter

August 25, 2016
(HealthDay)—A potentially deadly heart problem can run in families and occur at similar ages, a new study suggests.

Higher acute aortic dissection risk with lower-volume care

May 13, 2013
(HealthDay)—The mortality risk from emergency repair of acute aortic dissection is double when performed by lower-volume providers, according to research published in the May issue of the Annals of Thoracic Surgery.

Recommended for you

Gut protein mutations shield against spikes in glucose

November 20, 2018
Why is it that, despite consuming the same number of calories, sodium and sugar, some people face little risk of diabetes or obesity while others are at higher risk? A new study by investigators at Brigham and Women's Hospital ...

Proteins cooperate to break up energy structures in oxygen starved heart cells

November 19, 2018
During a heart attack, the supply of oxygen to heart cells is decreased. This reduced oxygen level, called hypoxia, causes the cell's powerhouses, the mitochondria, to fragment, impairing cell function and leading to heart ...

Bullying and violence at work increases the risk of cardiovascular disease

November 19, 2018
People who are bullied at work or experience violence at work are at higher risk of heart and brain blood vessel problems, including heart attacks and stroke, according to the largest prospective study to investigate the ...

Genetic analysis links obesity with diabetes, coronary artery disease

November 16, 2018
A Cleveland Clinic genetic analysis has found that obesity itself, not just the adverse health effects associated with it, significantly increases the risk of Type 2 diabetes and coronary artery disease. The paper was published ...

Non-coding genetic variant could improve key vascular functions

November 15, 2018
Atherosclerotic disease, the slow and silent hardening and narrowing of the arteries, is a leading cause of mortality worldwide. It is responsible for more than 15 million deaths each year, including an estimated 610,000 ...

Study of two tribes sheds light on role of Western-influenced diet in blood pressure

November 14, 2018
A South American tribe living in near-total isolation with no Western dietary influences showed no increase in average blood pressure from age one to age 60, according to a study led by researchers at Johns Hopkins Bloomberg ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.